Obesity in adults: Role of physical activity and exercise
- George A Bray, MD
George A Bray, MD
- Boyd Professor Emeritus, Pennington Biomedical Research Center/Louisiana State University
- Professor of Medicine Emeritus, Louisiana State University Health Science Center
- Leigh Perreault, MD
Leigh Perreault, MD
- Associate Professor of Medicine
- University of Colorado Anschutz Medical Campus
- Associate Professor of Epidemiology
- Colorado School of Public Health
A large body of observational data show an association between higher levels of physical activity and lower rates of many chronic diseases [1-5]. Conversely, physical inactivity is a component of reduced life expectancy [5,6]. The energy produced by physical activity is a component of energy balance that is particularly important in the pathogenesis of obesity and in its treatment. The components of energy expenditure are resting (basal) energy expenditure (REE) (eg, heat production for maintenance of body temperature, maintenance of ionic gradients across cells, and resting cardiac and respiratory function), diet-induced thermogenesis, and physical activity (figure 1) .
The optimal management of overweight and obesity starts with a combination of diet, exercise, and behavioral modification . In addition, some patients eventually require pharmacologic therapy or bariatric surgery. Physical exercise and activity are also important for maintaining long-term weight loss and can be beneficial in preserving lean body mass while dieting. A dose-response relationship has been demonstrated in overweight adult women between the amount of exercise and long-term weight loss maintenance .
This role of physical activity in the prevention and treatment of obesity will be reviewed here. Basal metabolic activities, thermogenesis, and other interventions in the management of obesity are reviewed separately. (See "Genetic contribution and pathophysiology of obesity" and "Obesity in adults: Overview of management" and "Obesity in adults: Behavioral therapy" and "Obesity in adults: Dietary therapy".)
Obesity in children and adolescents is reviewed separately. (See "Definition; epidemiology; and etiology of obesity in children and adolescents" and "Management of childhood obesity in the primary care setting".)
MEASUREMENT OF PHYSICAL ACTIVITY
The gold standard for measurement of total daily energy expenditure (TEE) is the doubly labeled water technique . Energy expenditure from activity can be estimated by subtracting resting energy expenditure (REE) and the thermic effect of food , also called diet-induced thermogenesis, from TEE measured by doubly labeled water technique. The physical activity level (PAL) can also be expressed as the ratio of TEE (from doubly labeled water) to REE and is usually in the range of 1.5 to 1.8.
- Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:S76.
- Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. US Department of Health and Human Services, Washington, DC, 2008.
- Warburton DE, Charlesworth S, Ivey A, et al. A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults. Int J Behav Nutr Phys Act 2010; 7:39.
- World Health Organization. Global Recommendations on Physical Activity for Health, WHO Press, Geneva, Switzerland 2010. (Available online at http://whqlibdoc.who.int/publications/2010/9789241599979_eng.pdf (accessed November 20, 2014)).
- Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012; 380:219.
- Sattelmair J, Pertman J, Ding EL, et al. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation 2011; 124:789.
- Westerterp KR. Assessment of physical activity: a critical appraisal. Eur J Appl Physiol 2009; 105:823.
- Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014; 129:S102.
- Jakicic JM, Marcus BH, Lang W, Janney C. Effect of exercise on 24-month weight loss maintenance in overweight women. Arch Intern Med 2008; 168:1550.
- Hills AP, Mokhtar N, Byrne NM. Assessment of physical activity and energy expenditure: an overview of objective measures. Front Nutr 2014; 1:5.
- Bonomi AG, Goris AH, Yin B, Westerterp KR. Detection of type, duration, and intensity of physical activity using an accelerometer. Med Sci Sports Exerc 2009; 41:1770.
- Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007; 298:2296.
- Harrington DM, Barreira TV, Staiano AE, Katzmarzyk PT. The descriptive epidemiology of sitting among US adults, NHANES 2009/2010. J Sci Med Sport 2014; 17:371.
- US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.
- Donnelly JE, Blair SN, Jakicic JM, et al. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 2009; 41:459.
- Bauman AE, Reis RS, Sallis JF, et al. Correlates of physical activity: why are some people physically active and others not? Lancet 2012; 380:258.
- Hankinson AL, Daviglus ML, Bouchard C, et al. Maintaining a high physical activity level over 20 years and weight gain. JAMA 2010; 304:2603.
- Moholdt T, Wisløff U, Lydersen S, Nauman J. Current physical activity guidelines for health are insufficient to mitigate long-term weight gain: more data in the fitness versus fatness debate (The HUNT study, Norway). Br J Sports Med 2014; 48:1489.
- Shook RP, Hand GA, Drenowatz C, et al. Low levels of physical activity are associated with dysregulation of energy intake and fat mass gain over 1 year. Am J Clin Nutr 2015; 102:1332.
- Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc 2009; 41:998.
- Ding D, Lawson KD, Kolbe-Alexander TL, et al. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet 2016; 388:1311.
- Lee IM, Djoussé L, Sesso HD, et al. Physical activity and weight gain prevention. JAMA 2010; 303:1173.
- McTiernan A, Sorensen B, Irwin ML, et al. Exercise effect on weight and body fat in men and women. Obesity (Silver Spring) 2007; 15:1496.
- Kilpeläinen TO, Qi L, Brage S, et al. Physical activity attenuates the influence of FTO variants on obesity risk: a meta-analysis of 218,166 adults and 19,268 children. PLoS Med 2011; 8:e1001116.
- Slentz CA, Duscha BD, Johnson JL, et al. Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE--a randomized controlled study. Arch Intern Med 2004; 164:31.
- Thorogood A, Mottillo S, Shimony A, et al. Isolated aerobic exercise and weight loss: a systematic review and meta-analysis of randomized controlled trials. Am J Med 2011; 124:747.
- Shaw K, Gennat H, O'Rourke P, Del Mar C. Exercise for overweight or obesity. Cochrane Database Syst Rev 2006; :CD003817.
- Ross R, Dagnone D, Jones PJ, et al. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial. Ann Intern Med 2000; 133:92.
- Irwin ML, Yasui Y, Ulrich CM, et al. Effect of exercise on total and intra-abdominal body fat in postmenopausal women: a randomized controlled trial. JAMA 2003; 289:323.
- Ross R, Janssen I, Dawson J, et al. Exercise-induced reduction in obesity and insulin resistance in women: a randomized controlled trial. Obes Res 2004; 12:789.
- Catenacci VA, Wyatt HR. The role of physical activity in producing and maintaining weight loss. Nat Clin Pract Endocrinol Metab 2007; 3:518.
- Villareal DT, Chode S, Parimi N, et al. Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med 2011; 364:1218.
- Jakicic JM, Marcus BH, Gallagher KI, et al. Effect of exercise duration and intensity on weight loss in overweight, sedentary women: a randomized trial. JAMA 2003; 290:1323.
- Goodpaster BH, Delany JP, Otto AD, et al. Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial. JAMA 2010; 304:1795.
- Chomentowski P, Dubé JJ, Amati F, et al. Moderate exercise attenuates the loss of skeletal muscle mass that occurs with intentional caloric restriction-induced weight loss in older, overweight to obese adults. J Gerontol A Biol Sci Med Sci 2009; 64:575.
- Shah K, Stufflebam A, Hilton TN, et al. Diet and exercise interventions reduce intrahepatic fat content and improve insulin sensitivity in obese older adults. Obesity (Silver Spring) 2009; 17:2162.
- Weinheimer EM, Sands LP, Campbell WW. A systematic review of the separate and combined effects of energy restriction and exercise on fat-free mass in middle-aged and older adults: implications for sarcopenic obesity. Nutr Rev 2010; 68:375.
- Ibañez J, Izquierdo M, Argüelles I, et al. Twice-weekly progressive resistance training decreases abdominal fat and improves insulin sensitivity in older men with type 2 diabetes. Diabetes Care 2005; 28:662.
- DiPietro L, Dziura J, Yeckel CW, Neufer PD. Exercise and improved insulin sensitivity in older women: evidence of the enduring benefits of higher intensity training. J Appl Physiol (1985) 2006; 100:142.
- Jakicic JM, Davis KK, Rogers RJ, et al. Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial. JAMA 2016; 316:1161.
- Finkelstein EA, Haaland BA, Bilger M, et al. Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial. Lancet Diabetes Endocrinol 2016; 4:983.
- Avenell A, Brown TJ, McGee MA, et al. What interventions should we add to weight reducing diets in adults with obesity? A systematic review of randomized controlled trials of adding drug therapy, exercise, behaviour therapy or combinations of these interventions. J Hum Nutr Diet 2004; 17:293.
- Turk MW, Yang K, Hravnak M, et al. Randomized clinical trials of weight loss maintenance: a review. J Cardiovasc Nurs 2009; 24:58.
- Mekary RA, Feskanich D, Hu FB, et al. Physical activity in relation to long-term weight maintenance after intentional weight loss in premenopausal women. Obesity (Silver Spring) 2010; 18:167.
- Miller WC, Koceja DM, Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes Relat Metab Disord 1997; 21:941.
- Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr 2005; 82:222S.
- WHO Global Recommendations on Physical Activity for Health, 2010. http://whqlibdoc.who.int/publications/2010/9789241599979_eng.pdf (Accessed on February 08, 2013).
- Hunter GR, Brock DW, Byrne NM, et al. Exercise training prevents regain of visceral fat for 1 year following weight loss. Obesity (Silver Spring) 2010; 18:690.
- Sui X, LaMonte MJ, Laditka JN, et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA 2007; 298:2507.
- Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 2009; 301:2024.
- Fogelholm M. Physical activity, fitness and fatness: relations to mortality, morbidity and disease risk factors. A systematic review. Obes Rev 2010; 11:202.
- Stevens J, Cai J, Evenson KR, Thomas R. Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. Am J Epidemiol 2002; 156:832.
- Hu FB, Willett WC, Li T, et al. Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med 2004; 351:2694.
- Wadden TA, Webb VL, Moran CH, Bailer BA. Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation 2012; 125:1157.
- Fan JX, Brown BB, Hanson H, et al. Moderate to vigorous physical activity and weight outcomes: does every minute count? Am J Health Promot 2013; 28:41.
- Mathus-Vliegen EM, Obesity Management Task Force of the European Association for the Study of Obesity. Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline. Obes Facts 2012; 5:460.
- Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev 2009; :CD002759.
- Davidson LE, Hudson R, Kilpatrick K, et al. Effects of exercise modality on insulin resistance and functional limitation in older adults: a randomized controlled trial. Arch Intern Med 2009; 169:122.
- Peirson L, Douketis J, Ciliska D, et al. Treatment for overweight and obesity in adult populations: a systematic review and meta-analysis. CMAJ Open 2014; 2:E306.
- Andersen RE, Wadden TA, Bartlett SJ, et al. Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial. JAMA 1999; 281:335.
- MEASUREMENT OF PHYSICAL ACTIVITY
- PREVENTION OF WEIGHT GAIN
- TREATMENT FOR OBESITY
- Exercise as a single treatment
- Exercise plus diet
- Addition of "activity trackers"
- Maintenance of weight loss
- OVERALL HEALTH
- A PROGRAM FOR PHYSICAL ACTIVITY
- Pre-exercise evaluation
- Exercise duration
- Exercise type and intensity
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS